Patient-reported intra-dialytic symptoms and post-dialysis recovery times are influenced by psychological distress rather than dialysis prescription

Abstract Background Dialysis is a life-sustaining treatment, but many patients suffer symptoms during dialysis and take time to recover. Previous reports have linked recovery time to intra-dialytic hypotension and rapid solute clearances, whereas others have reported an association with psychological factors. As such, we wished to investigate which factors were important in determining symptom self-reporting and delayed recovery times. Methods We recorded self-reported patient intra-dialytic symptoms, recovery times along with sessional dialysis prescriptions, blood pressure and urea clearance, and distress thermometer scores to assess psychological factors. Findings Six hundred twenty-three dialysis patients were studied; 621 treated by haemodiafiltration, 60.8% male, mean age 64.5 ± 16.2 years, and 46.1% diabetic. Almost half (49.6%) reported recovery within 1 h. On multivariate analysis, patient self-reported symptom scores were associated with longer post-dialysis recovery times (odds ratio (OR) 1.61, 95% confidence limits (CL) 1.33–1.95), higher distress thermometer scores (OR 1.3 CL (1.3–1.39), but lower hand grip strength (OR 0.85 CL (0.93–0.94), all p < 0.001, and younger rather than older patients (OR 0.98 CL (0.97–0.99) p = 0.005. We found no association with ultrafiltration rates or weight loss. Discussion Compared to earlier studies, our patients treated by haemodiafiltration reported fewer symptoms and shorter recovery times. Patients with higher self-reported distress thermometer scores had both longer post-dialysis recovery times and greater dialysis symptom scores. Younger patients reported more dialysis symptoms and longer recovery times than older patients. Future studies investigating patient self-reported recovery times and dialysis-associated symptoms should also consider interventions to reduce patient psychological factors as well as dialysis practices

Relationships Between Peritoneal Protein Clearance and Parameters of Fluid Status Agree with Clinical Observations in Other Diseases that Venous Congestion Increases Microvascular Protein Escape

BACKGROUND: Peritoneal effluent from peritoneal dialysis (PD) patients contains proteins, mainly transported from the circulation through large pores in the venular part of the peritoneal microvessels. Hydrostatic convection is the major driver for peritoneal protein transport, although in PD there is additional diffusion. Consequently, venous pressure may have a role in peritoneal protein transport. The aim of the study was to investigate the importance of venous congestion on the magnitude of peritoneal protein clearance in incident PD patients using non-invasive measurements. METHODS: A total of 316 adult PD patients, on PD for 8 - 12 weeks and collecting 24-hour urine and dialysate for total protein determination, underwent standard peritoneal equilibration testing (PET) along with measurement of N terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP), multifrequency bioimpedance analysis, and a transthoracic echocardiogram. RESULTS: Statistically significant univariate relationships for peritoneal protein clearance with a Spearman correlation coefficient > 0.25 were present for 4-hour dialysate/plasma (D/P) creatinine, NT-proBNP, extracellular/total body water, extracellular water excess, left ventricular mass, and right atrial area. Negative correlations were found with serum total protein and residual renal function. On multivariate analysis, logNTproBNP (β 0.11, p = 0.007) and right atrial area (β 0.01, p = 0.03) were significant independent predictors of peritoneal protein clearance. CONCLUSION: Indicators of venous congestion showed the most important relationships with peritoneal protein clearance. These indicators have not been assessed in previous studies on the presence or absence of relationships between peritoneal protein clearance and mortality